Provider Demographics
NPI:1760986780
Name:GEORGETOWN CHIROPRACTIC AND REHABILITATION
Entity Type:Organization
Organization Name:GEORGETOWN CHIROPRACTIC AND REHABILITATION
Other - Org Name:SPENCER CHIROPRACTIC AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING DC, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-283-9313
Mailing Address - Street 1:40 W GUDE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1119
Mailing Address - Country:US
Mailing Address - Phone:301-637-9419
Mailing Address - Fax:
Practice Address - Street 1:40 W GUDE DR STE 250
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1119
Practice Address - Country:US
Practice Address - Phone:607-283-9313
Practice Address - Fax:301-850-2031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGETOWN CHIROPRACTIC AND REHABILITATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-23
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty